Provider Demographics
NPI:1053897546
Name:PETERSEN, KARI LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:LYNN
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 CUNNINGHAM AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1593
Mailing Address - Country:US
Mailing Address - Phone:417-782-1910
Mailing Address - Fax:417-782-1844
Practice Address - Street 1:2702 CUNNINGHAM AVE STE A
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1593
Practice Address - Country:US
Practice Address - Phone:417-782-1910
Practice Address - Fax:417-782-1844
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator